| Object To Explore the the Influence of target blood glucose control with insulin therapy on immunefunction in patients with sepsis.Method This research was randomness prospective,double-blind, clinical controlled studies.90septicpatients were randomly divided into three groups: target glucose control A group30cases(glucose control in4.4-6.1mmol/L),target glucose control B group30cases (glucose control in6.2-8.3mmol/L)and target glucose control C group30cases(glucose control in8.4-10.0mmol/L).In admitted cased were given target blood glucose, Enzyme linkedimmunosorbent assay(ELISA)was used to express the level of IL-6and IL-10in0、1、3、7dayduring the patients lived in the ICU.The flow cytometry(FCM)and monoclonal antibodies wasused to express the level of activation inducer molecule T lymph cell CD69and CD14+monocyte human leukocyte antigen (locus) DR in0、1、3、7day during the patients live in theICU. At the same time, observing Score of acute physiology and chronic healthevaluationⅡ(APACHEⅡ)and record28days (d) mortality、the MODS and hypoglycemiaincidence rate.Result The1d、3d and7d compared with the admission time, In the A group the level of IL-6wasreduced and IL-10was raised capability were higher than B and C group with passage of time,andthe difference was statistically significant (P＜0.05or P＜0.01);Group A compared with B andC,the target glucose control therapy can be reduced the level of IL-6and raised the express ofIL-10,especially on the fifth day and the seventh day,and the difference was statisticallysignificant(P＜0.05);The expression of IL-6in C group was decreased at first and then increased atlast, but the expression of IL-10was on the contrary,the difference was no significant(P＞0.05).Inthe three groups the level of CD69was raised at the1d、3d and7d,it was capability higher than Band C group with passage of time,and the difference was statistically significant (P＜0.05or P＜0.01);The expression level of T lymph cell CD69in A group and B group were decreased as theduration of treatment time,otherwise the C group was increased at first and then decreased atlast,especially on the seventh day,and the difference was statistically significant(p＜0.05).At the1d、3d and7d compared with the0d the expression level of CD14+monocyte human leukocyte antigen(locus)DR was raised in the three groups,and the difference was statistically significant (P＜0.05orP＜0.01).The expression level of CD14+monocyte human leukocyte antigen (locus)DR wassignificantly higher in A group than B、C group，the difference was statistically significant (P＜0.05).In the three groups,observed the Score of acute physiology and chronic health evaluationⅡ(APACHEⅡ)at the1d、3d and7d were reduced than the admission time,and the difference wasstatistically significant (P＜0.05or P＜0.01);Group A compared with the B、 Cgroup,APACHEⅡscore was decreased with passage of time,the seventh day was obvious lowerthan the first day for the APACHEⅡ,and the difference was statistically significant (P＜0.05).The 28days (d) mortality and the MODS incidence rate of A group was lower than B、C group，but thedifference was no significant (P＞0.05).The hypoglycemia incidence rate was no significant in thethree groups(P＞0.05).Conclusion Target glucose control management at4.6-6.1mmol/L can reduce the level of IL-6and risethe level of IL-10,take advantage of balance organism inflammatory and anti-inflammatory.Target glucose control management at4.6-6.1mmol/L promote the expression level of Tlymph cell CD69and human leukocyte antigen (locus) DR onCD14+monocyte, can helprestore the function of T lymph cell,it was benefit for clear the body of pathogenicmicroorganisms and recovery of immune homeostasis. Target glucose control management at4.6-6.1mmol/L promote the expression level of T lymph cell CD69and human leukocyteantigen (locus) DR on CD14+monocyte can better reflect more favorable cellular immunestatus in ill patients with sepsis，and it was benefit for the malignant processes of terminatethe immune paralysis and immune disorders in ill patients with sepsis. |
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